Incidence and prevalence of multiple sclerosis in the UK 1990-2010: a descriptive study in the General Practice Research Database.

OBJECTIVES: To estimate the incidence and prevalence of multiple sclerosis (MS) by age and describe secular trends and geographic variations within the UK over the 20-year period between 1990 and 2010 and hence to provide updated information on the impact of MS throughout the UK. DESIGN: A descriptive study. SETTING: The study was carried out in the General Practice Research Database (GPRD), a primary care database representative of the UK population. MAIN OUTCOME MEASURES: Incidence and prevalence of MS per 100 000 population. Secular and geographical trends in incidence and prevalence of MS. RESULTS: The prevalence of MS recorded in GPRD increased by about 2.4% per year (95% CI 2.3% to 2.6%) reaching 285.8 per 100 000 in women (95% CI 278.7 to 293.1) and 113.1 per 100 000 in men (95% CI 108.6 to 117.7) by 2010. There was a consistent downward trend in incidence of MS reaching 11.52 per 100 000/year (95% CI 10.96 to 12.11) in women and 4.84 per 100 000/year (95% CI 4.54 to 5.16) in men by 2010. Peak incidence occurred between ages 40 and 50 years and maximum prevalence between ages 55 and 60 years. Women accounted for 72% of prevalent and 71% of incident cases. Scotland had the highest incidence and prevalence rates in the UK. CONCLUSIONS: We estimate that 126 669 people were living with MS in the UK in 2010 (203.4 per 100 000 population) and that 6003 new cases were diagnosed that year (9.64 per 100 000/year). There is an increasing population living longer with MS, which has important implications for resource allocation for MS in the UK.

Antiplatelet drug interactions.

Both laboratory studies in healthy volunteers and clinical studies have suggested adverse interactions between antiplatelet drugs and other commonly used medications. Interactions described include those between aspirin and ibuprofen, aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs), and the thienopyridine, clopidogrel, and drugs inhibiting CYP2C19, notably the proton pump inhibitors (PPI) omeprazole and esomeprazole. Other interactions between thienopyridines and CYP3A4/5 have also been reported for statins and calcium channel blockers. The ibuprofen/aspirin interaction is thought to be caused by ibuprofen blocking the access of aspirin to platelet cyclo-oxygenase. The thienopyridine interactions are caused by inhibition of microsomal enzymes that metabolize these pro-drugs to their active metabolites. We review the evidence for these interactions, assess their clinical importance and suggest strategies of how to deal with them in clinical practice. We conclude that ibuprofen is likely to interact with aspirin and reduce its anti-platelet action particularly in those patients who take ibuprofen chronically. This interaction is of greater relevance to those patients at high cardiovascular risk. A sensible strategy is to advise users of aspirin to avoid chronic ibuprofen or to ingest aspirin at least 2 h prior to ibuprofen. Clearly the use of NSAIDs that do not interact in this way is preferred. For the clopidogrel CYP2C19 and CYP3A4/5 interactions, there is good evidence that these interactions occur. However, there is less good evidence to support the clinical importance of these interactions. Again, a reasonable strategy is to avoid the chronic use of drugs that inhibit CYP2C19, notably PPIs, in subjects taking clopidogrel and use high dose H2 antagonists instead. Finally, anti-platelet agents probably interact with other drugs that affect platelet function such as selective serotonin reuptake inhibitors, and clinicians should probably judge patients taking such combination therapies as at high risk for bleeding.

The use of 18-fluoro-dihydroxyphenylalanine and 18-fluorodeoxyglucose positron emission tomography scanning in the assessment of metaiodobenzylguanidine-negative phaeochromocytoma.

123I-metaiodobenzylguanidine (123I-MIBG) scintigraphy scanning is commonly used in the imaging of phaeochromocytoma (and paraganglioma) to confirm the site of disease and whether any spread has occurred. However, 123I-MIBG imaging is negative in 15% of cases of benign phaeochromocytoma and around 50% of cases of malignant phaeochromocytoma. In recent years, positron emission tomography (PET) scanning using various different radiotracers has been shown to be a good alternative or supplementary investigation in phaeochromocytoma. We present the cases of four patients with symptoms and signs suggestive of phaeochromocytoma, but who had negative 123I-MIBG scans, and illustrate the usefulness of 18-fluoro-dihydroxyphenylalanine PET scanning in their assessment. In one of the patients, we illustrate how fluorodeoxyglucose PETscanning can provide useful information about the extent of malignant disease. These illustrative cases lend further support for the use of PET scanning in the assessment of phaeochromocytoma and suggest that it may have a particularly important role in the investigation of patients in whom 123I-MIBG scanning is negative.

Grand Rounds at the British Hypertension Society: renal artery stenosis.

Renal artery angioplasty for renovascular hypertension is a controversial subject with considerable data but few certainties. This article is a summary of the Grand Round on Renovascular Hypertension held at the British Hypertension Society Annual Conference in September 2006.

NMR detection and one-dimensional imaging using the inhomogeneous magnetic field of a portable single-sided magnet.

A portable, nuclear magnetic resonance (NMR) probe is described which utilises the intrinsic inhomogeneity of the field produced by a single-sided magnet to provide spatial encoding of the NMR signal. The probe uses a longitudinally magnetized hollow cylinder, and a figure-8 radiofrequency (RF) surface coil. The system has been used to measure NMR relaxation times and one-dimensional NMR profiles of rubber phantoms.

Infliximab improves endothelial dysfunction in systemic vasculitis: a model of vascular inflammation.

BACKGROUND: Endothelial vasomotor dysfunction and markers of systemic inflammation are independent determinants of cardiovascular risk. However, the link between clinical inflammation and endothelial dysfunction is unclear. The aim of this study was to use anti-neutrophil cytoplasmic antibody-associated systemic vasculitis (AASV) as a model of systemic inflammation in which to test the hypothesis that inflammation is associated with endothelial dysfunction and can be reversed with anti-tumor necrosis factor-alpha (TNF-alpha) therapy. METHODS AND RESULTS: Fourteen patients with active AASV and 21 age-matched control subjects were studied. Endothelial function was assessed through the use of forearm plethysmography and related to clinical disease activity: Birmingham Vasculitis Activity Score (BVAS) and serum levels of C-reactive protein (CRP), interleukin-6 (IL-6), and TNF-alpha. The effects of anti-TNF-alpha therapy (infliximab), either alone (n=6) or in combination with standard treatment (n=4), on endothelial function were subsequently determined. Patients had a mean BVAS of 11+/-1, and CRP and IL-6 were higher in the AASV group than in control subjects (34.8+/-10.5 versus 1.6+/-0.2 pg/mL, P<0.001; 9.0+/-0.7 versus 6.7+/-0.6 pg/mL, P=0.02). Forearm blood flow response to acetylcholine (ACh) was reduced in the patients compared with control subjects (P=0.002), but sodium nitroprusside (SNP) responses were not (P=0.3). The response to ACh improved with infliximab treatment (P=0.004) in particular, with infliximab alone (P=0.03). CONCLUSIONS: AASV is associated with endothelial dysfunction. Anti-TNF-alpha therapy, alone or in combination with standard treatment, results in clinical remission, reduced inflammation, and improved endothelium-dependent vasomotor responses.

A comparison of tactile, auditory, and visual feedback in a pointing task using a mouse-type device.

A mouse was modified to add tactile feedback via a solenoid-driven pin projecting through a hole in the left mouse button. An experiment is described using a target selection task under five different sensory feedback conditions ('normal', auditory, colour, tactile, and combined). No differences were found in overall response times, error rates, or bandwidths; however, significant differences were found in the final positioning times (from the cursor entering the target to selecting the target). For the latter, tactile feedback was the quickest, normal feedback was the slowest. An examination of the spatial distributions in responses showed a peaked, narrow distribution for the normal condition, and a flat, wide distribution for the tactile (and combined) conditions. It is argued that tactile feedback allows subjects to use a wider area of the target and to select targets more quickly once the cursor is inside the target. Design considerations for human-computer interfaces are discussed.

A note on the information-theoretic basis of Fitts' law.

Fitts' law is an information-theoretic view of human motor behavior developed from Shannon's Theorem, 17, a fundamental theorem of communications systems. Using data from Fitts' original experiments, we demonstrate that Fitts' choice of an equation that deviates slightly from the underlying principal is perhaps unfounded, and that the relationship is improved by using an exact adaptation of Shannon's equation.

Acetylcholine-induced metabolic changes in the perfused rabbit mandibular salivary gland studied by 31P-NMR spectroscopy.

Changes in the content of high-energy phosphates, intracellular pH (pHi) and the ratio of MgATP to total ATP ([MgATP]/[ATP]t) resulting from continuous stimulation with acetylcholine (10(-9) to 10(-4) M) were measured by 31P-NMR spectroscopy in the isolated, perfused rabbit mandibular gland at 37 degrees C. With 10(-9) to 10(-7) M acetylcholine, no significant changes in these parameters were observed. On stimulation with 10(-6) M acetylcholine, the optimal concentration for sustained secretion, the content of ATP decreased by 28 +/- 10% (mean +/- S.E.; n = 8) of its control value. pHi decreased initially by approx. 0.05 pH unit, then showed an alkalinization of 0.09 +/- 0.02 pH unit (n = 8). With 10(-5) and 10(-4) M acetylcholine, changes in ATP and pHi were similar to those induced by 10(-6) M acetylcholine: the total content of high-energy phosphates remained at approx. 70% of the control value and no decrease in [MgATP]/[ATP]t was observed. As possible causes of the reduced secretory rate observed with higher concentrations of acetylcholine (10(-5) to 10(-3) M), we can exclude depletion of high-energy phosphates, inhibition of metabolism caused by intracellular acidosis, and inhibition of ATP usage caused by a decrease in MgATP availability.

High resolution nuclear magnetic resonance imaging of pig knees at 4.7 T.

We present images of the pig knee joint which illustrate the resolution that is easily obtainable in high field (4.7 T) NMR imaging. We also describe a variant of the birdcage resonator which utilizes a novel tuning mechanism of simple construction.

A simple field map for shimming.

A field-mapping procedure based on volume-selective spectroscopy is described. For proton NMR the method may be used to optimize magnet shimming, on the sample under investigation, prior to spectroscopy or imaging experiments. Examples of field maps obtained on our 4.7-T system, using phantoms and biological samples of up to 6 cm in diameter, are presented.